Neck and Shoulder Pain: Prevalence and Risk Factors Among Omani School Teachers

Abstract

Background: Neck and shoulder pain are prevalent occupational health issues among school teachers globally, impacting work performance and quality of life. This study aimed to assess the prevalence and factors associated with neck and shoulder pain among school teachers in Oman. Methods: A cross-sectional study using chi-square and logistic regression analyses was conducted in March–April 2025 among 419 full-time school teachers in three Omani governorates. A structured questionnaire was used to collect data on socio-demographic, behavioral, physical, psychosocial, and health-related factors. Results: A high prevalence of neck and shoulder pain among participants was observed, with 98.3% reporting pain in the past 12 months. Chronic pain lasting over a year was reported by 59.7%, with 37.0% experiencing severe pain. Psychological job demands were high, with 62.8% reporting high levels of stress. Conclusions: The study did not find significant associations with physical risk factors, but highlighted the importance of broader determinants such as low physical activity, obesity, and lack of supervisory support in relation to chronic neck and shoulder pain among teachers.

1. Introduction

Musculoskeletal disorders (MSDs) are a significant occupational health issue worldwide, especially in professions involving prolonged static postures and repetitive tasks. Neck and shoulder pain are common in these professions and can lead to disability and decreased work productivity. Educators often experience these conditions due to the physical and psychological demands of their job, such as prolonged standing, grading papers, and high classroom stress. MSDs are a prevalent health concern for teachers, caused by repetitive movements, poor posture, and work-related stress. Approximately 30% of MSD cases are attributed to poor working conditions, making it a significant public health issue for teachers.

Teaching involves frequent head-down postures, which can strain the cervical spine. Chronic neck pain can lead to muscle weakness, reduced endurance, and psychological distress. Psychological factors such as stress, anxiety, and sleep disturbances, as well as biological factors like aging and autoimmune disorders, contribute to the development of neck pain.

Numerous studies have shown that neck pain is a common issue among teachers. A meta-analysis of 44 studies found that musculoskeletal disorders (MSDs) affect around 68% of teachers, with neck pain being prevalent in approximately 47% of them [1]. Another review by Erick and Smith (2011) reported that self-reported MSD prevalence among teachers ranges from 39% to 95%, with the neck, back, and upper limbs being the most commonly affected areas [2].

In a survey of 3100 secondary school teachers in Hong Kong, a lifetime prevalence of neck pain was reported at 69.3%, indicating that a significant portion of educators may experience neck pain at some point in their careers [3]. Studies in different countries have shown varying rates of neck pain among teachers, with prevalence ranging from 32% in Brazil to 73.5% in India [4]. A study in Ethiopia found that 57.3% of teachers reported neck pain, highlighting it as a common occupational health concern [5].

Research from various regions, including China, Saudi Arabia, Iran, and Egypt, has also shown high rates of neck pain among teachers. In Saudi Arabia, studies have reported neck pain prevalence ranging from 42.1% to 49.8% among secondary school teachers [6]. Similarly, studies in Iran and Egypt found neck pain prevalence of 37% and 56.1%, respectively [7,8].

Overall, the global literature indicates that a significant number of school teachers worldwide are likely to experience neck pain or related musculoskeletal issues during their careers. The prevalence of neck pain among teachers remains consistently high across different countries, reflecting the challenges faced by educators in maintaining their physical well-being.

While international studies have examined this issue, there is limited data specific to the Omani context. Teachers in Oman may face specific environmental, organizational, and cultural factors that contribute to neck and shoulder pain. These factors can include ergonomic issues, long hours of standing or sitting, heavy workloads, and cultural norms that may affect their posture and movement patterns. It is important for teachers to be aware of these factors and take proactive measures to prevent and manage neck and shoulder pain. This can include maintaining good posture, taking regular breaks, using ergonomic furniture and equipment, and seeking medical advice if needed. By addressing these factors, teachers can reduce their risk of developing neck and shoulder pain and improve their overall well-being. Hence, this study aimed to address the gap in local literature and offer evidence-based insights pertinent to Omani schools and teachers. The research findings will aid in the creation of specific ergonomic interventions, inform Ministry of Education policymakers, and raise awareness among school administrators about the importance of preventive measures. Additionally, it will establish a foundation for future studies and occupational health monitoring in Oman’s education sector.

The main objective of this study was to analyze the prevalence and risk factors of neck and shoulder pain among school teachers in selected regions of Oman. The study aimed to:

• Determine the 12-month prevalence of neck and shoulder pain among Omani school teachers.
• Identify socio-demographic, behavioral, physical, and psychosocial factors linked to neck and shoulder pain.
• Assess the severity, duration, and impact of neck and shoulder pain on work performance and absenteeism.
• Offer evidence-based recommendations for ergonomic and occupational health interventions in the education sector.

2. Methods

This study used a quantitative cross-sectional design to examine the prevalence of neck pain and its associated risk factors among school teachers in Oman. Data was collected from a sample of the population to provide insights into the issue. This design is ideal for estimating health conditions’ prevalence and exploring relationships between variables like neck pain and potential risk factors without altering any exposures or outcomes. The study is observational, with no interventions, and relies on self-reported data. A structured questionnaire was used for objective measurement of neck pain occurrence and statistical analysis of hypothesized risk factors.

The study was conducted in three governorates in the Sultanate of Oman: Al Dakhiliyah, Al Buraimi, and South Al Batinah, representing different school environments in Oman, including interior, border, and coastal areas. Al Dakhiliyah Governorate, located in the interior, Al Buraimi on the northwest border with the UAE, and South Al Batinah on the coast west of Muscat, were part of the study. These regions have a mix of government and private schools from primary to secondary levels, providing a diverse group of teachers for the research. The selection of multiple locations enhances the geographic diversity of the sample, improving the generalizability of the findings to the broader context of Oman. Administrative and Ethical Approvals were secured from the Ministry of Education and the University of Nizwa’s Research Ethics Committee [No.: 2825655413]. The Educational authorities in each governorate collaborated to distribute the survey, ensuring that teachers from both government and private schools in Al Dakhiliyah, Al Buraimi, and South Al Batinah were invited to participate.

The study focused on full-time government and private school teachers in Oman, specifically in the three selected governorates, covering public primary, preparatory, and secondary schools under the Ministry of Education. In the 2023/2024 academic year, out of 57,033 teachers, 39,637 (69.5%) are female and 17,396 (30.5%) are male [9]. The inclusion criteria were full-time teachers in government and private schools in the selected regions during the data collection period, regardless of subject specialization or grade level. Part-time instructors and training staff without full-time teaching duties were excluded.

A convenience sampling method was used due to the study’s scope and logistical constraints. All available teachers in the three regions were invited to participate voluntarily, with the survey link widely distributed to maximize response rates. While this approach may introduce self-selection bias, it was deemed appropriate for an exploratory prevalence study. Sampling was based on convenience and accessibility through existing communication channels such as WhatsApp groups and email lists, and due to the open dissemination of the survey link through official channels and teacher groups, the exact number of invited teachers could not be determined; therefore, a response rate could not be computed, which may have introduced non-response bias.

Data collection began on 17 March 2025, when the survey was sent to school administrations, and ended on 19 April 2025, when responses were closed in Google Form. After data collection, responses were summarized to form the final sample of 419 teachers (46 male, 373 female) from Al Dakhiliyah, Al Buraimi, and South Al Batinah who met the inclusion criteria. This sample was used for analysis, providing insights into the prevalence of neck pain among Omani school teachers in the selected regions.

Data were collected using a structured questionnaire in Arabic, the primary language of the participants, to ensure clarity and ease of understanding. The questionnaire was formatted as an online survey using Google Forms for electronic completion via computer or smartphone. It covered various aspects:

• Demographic Information: age, gender, marital status, dominant hand, height, and weight.
• School Information: school level, working organization, and school building shape.
• Behavioral Factors: type, level, and frequency of physical activity.
• Neck Pain History and Symptoms: inquiry about neck pain experience, severity, and frequency, including pain characteristics, duration, and impact on daily activities.
• Professional Profile: teaching experience, school level, subject taught, average daily work hours, and additional responsibilities.
• Work Environment and Habits: classroom setting, work conditions, posture, computer use, standing/writing duration, and ergonomic furniture availability.
• Comorbidities: existing health conditions affecting shoulder and neck pain, such as diabetes, hypertension, respiratory diseases, surgeries, or injuries.
• Psychosocial Factors: job demands, supervisor and coworker support, and job satisfaction to assess stress, well-being, and musculoskeletal pain on teachers.

The questionnaire included closed-ended questions, such as multiple-choice or Likert-scale formats, to facilitate quantitative analysis. The questionnaire relied on validated instruments in musculoskeletal research to ensure content validity, including items adapted from the Nordic Musculoskeletal Questionnaire (NMQ). The NMQ is commonly used in occupational health to identify work-related musculoskeletal disorders.

The analyzis of global application of the NMQ across various sectors, highlighting its role in identifying musculoskeletal symptoms. The advantages of the NMQ include standardization, international acceptance, cost-effectiveness, and applicability in different occupational settings [10].

An Arabic version of the Nordic Musculoskeletal Questionnaire was used. The questionnaire underwent expert review and pilot testing to ensure validity and clarity. Content validity was checked by academic and language experts, with minor modifications made based on feedback and cultural adaptation prior to data collection.

A pilot study with 10 school teachers provided positive feedback on the questionnaire’s relevance and clarity. After revisions, the questionnaire was finalized for distribution to the target population. Although formal reliability testing was not conducted, content validity was established through expert review and pilot testing.

Data collection was initiated after obtaining necessary approvals, including Administrative and Ethical Approvals from the Ministry of Education and the University of Nizwa’s Research Ethics Committee. Coordination with Educational Directorates in Al Dakhiliyah, Al Buraimi, and South Al Batinah was essential for distributing the online survey to teachers in government schools across the regions. The survey link was shared via WhatsApp and email to reach teachers, ensuring participant confidentiality.

To maintain anonymity, no personal identifiers were collected in the survey. Teachers could complete the survey at their convenience using any internet-enabled device. Reminder messages were sent one week after the initial survey distribution to boost response rates. Follow-up calls were made to select schools, especially private schools, to ensure participation. The survey was open for 4–6 weeks, starting on 17 March 2025, allowing busy teachers ample time to participate. After closing the survey, all data were securely stored for analysis.

3. Results

Data were collected using Google Forms and then exported to Microsoft Excel for initial cleaning and organization. The dataset was further refined in IBM SPSS version 16 for detailed analysis.

Descriptive statistics, such as frequencies, percentages, and means, were utilized to summarize participant demographics, physical activity levels, neck and shoulder pain prevalence, and psychosocial factors.

Inferential statistical tests were conducted to examine the relationship between neck and shoulder pain and potential risk factors. The Chi-square test was employed for categorical variables to determine significant associations. Only complete responses (N = 419) were included in the final analysis to ensure data accuracy, with incomplete or duplicate entries removed during data cleaning. A significance level of p < 0.05 was used for all analyses. Results were presented in tables and graphs to enhance clarity and interpretation.

In addition to descriptive and Chi-square analyses, regression models were applied to identify independent predictors of neck and shoulder pain outcomes. Ordinal logistic regression was used for pain severity (none, mild, moderate, severe), while binary logistic regression was employed for pain chronicity (acute vs. chronic). Predictor variables included demographic (age, gender, BMI, marital status, teaching experience), work-related (school level, organization type, posture, hours of standing/sitting), psychosocial (job satisfaction, supervisor support, coworker support, stress), and behavioral factors (physical activity). All independent variables were entered simultaneously into the regression models using the enter method.

Table 1. Demographic data of the study participants.

Variables		Frequency	Percent
Gender	Female	373	89.0
	Male	46	11.0
Age	20–25 Years	20	4.8
	25–35 Years	129	30.8
	35–45 Years	219	52.3
	More than 45 Years	51	12.2
Marital Status	Divorced	7	1.7
	Married	363	86.6
	No answer	1	0.2
	Single	46	11.0
	Widowed	2	0.5
Dominant Hand	Left	29	6.9
	Right	390	93.1
BMI	Obese [≥30]	98	23.4
	Over Weight (25–29.9)	153	36.5
	Normal weight (18.5–24.9)	149	35.6
	Underweight [<18.5]	19	4.5
School Level	High school (11–12)	66	15.8
	Primary (1–4)	211	50.4
	Secondary (5–10)	142	33.9
School Organization	Governmental	379	90.5
	Private	40	9.5
	Two floors	355	84.7

summarizes the demographic data of the survey participants.

The majority of participants (98.3%) reported neck or shoulder pain in the past year. The most common sites were neck and shoulders (46.5%), followed by upper back (23.2%). 67.8% had a gradual onset, 32.2% sudden onset. 59.7% had chronic pain, others had pain for 1–3 months (17.9%), 6 months (13.1%), or 1 week (9.3%). Pain severity: moderate (48.4%), severe (37.0%), mild (11.5%), no pain (3.1%). Pain distribution: both sides (45.1%), right side (30.1%), left side (24.8%). 73.3% had pain radiating into the arm or hand. Regarding absenteeism, 29.6% reported taking leave from school due to pain. In terms of treatment, 43.2% used painkillers only, 20.5% underwent physical therapy, 2.6% consulted an orthopedic doctor, and 33.7% did not receive any treatment.

Table 2. Pain pattern and prevalence.

Variable	Category	Pain Prevalence (%)
Location of pain	Neck	19.3%
	Neck and shoulders	46.5%
	Shoulders	10.9%
	Upper back	23.15%
Onset of pain	Gradually	67.78%
	Suddenly	32.22%
Pain duration	3 to 6 months	31.01%
	<A week	9.33%
	Chronic > 1 year	59.66%
Pain severity	Mild (1–4)	11.5%
	Moderate (5–7)	48.4%
	Severe (8–10)	37.0%
	No response	3.1%
Side of pain	Both sides	45.1%
	Left	24.8%
	Right	30.1%
Leave taken due to pain	No	70.4%
	Yes	29.6%

summarizes the pain pattern and prevalence.

The descriptive analysis of the important anthropometric parameters is provided in

Table 3. Descriptive analysis of Anthropometric parameters.

		SD	Median	Confidence Level (95.0%)
Height	159.35	7.04	45	0.676
Weight	67.10	14.43	64	1.385
BMI	26.35	5.05	25.96	0.484

and

Table 4. Classification as per BMI range (Obese).

BMI Range	Number of Participants	Percentage
30–35	76	18.1
≥35	16	3.8
≥40	6	1.4

below.

The Chi-square analysis revealed no significant association between pain prevalence and the variables examined. Factors such as work experience (p = 0.740), number of students per class (p = 0.498), and number of weekly classes (p = 0.307) did not show a significant impact on the presence of neck and/or shoulder pain among teachers (

Table 5. Pain prevalence association with work experience and workload.

Variable	Category	Pain Prevalence (%)	p-Value
Work experience	0–5 years	97.2%	0.740
	5–10 years	98.0%	0.740
	10–20 years	98.9%	0.740
Number of students per class	20–25 students	97.0%	0.498
	25–35 students	98.7%	0.498
Number of weekly classes	15–25 classes	98.8%	0.307
	7–14 classes	96.5%	0.307

).

Neck and shoulder pain were prevalent among teachers across various occupational factors. Spending more than two hours per day with head down or arms raised above the head showed a pain prevalence of 98.3%. Standing for more than two hours had a prevalence of 98.6%, while sitting continuously for more than four hours had the highest prevalence at 98.7%. Teachers without comfortable back support during sitting reported a slightly lower prevalence of 97.9%. None of these associations was statistically significant (p > 0.05) (

Table 6. Association between Work-related factors and pain prevalence.

Variable	Pain Prevalence (%)	p-Value
Spend > 2 h/day head down	98.3%	0.942
Raise arm > 2 h	98.3%	0.850
Stand > 2 h	98.6%	0.222
Sit > 4 h	98.7%	0.678
Comfortable back support	97.9%	0.383

).

Regarding psychosocial factors, 55.6% of participants were satisfied with their job, with 15.0% being very satisfied and 18.6% dissatisfied. Co-worker support was reported as always by 34.6% and sometimes by 50.4%, while 11.9% rarely received support and 3.1% never did. Support from family and friends was always reported by 33.4% and sometimes by 47.0% of teachers. Supervisor support was lower, with 16.2% always receiving support, 47.3% sometimes, and 23.9% rarely. In terms of psychological demand, 62.8% always experienced pressure, 31.7% sometimes, and only 5.5% low levels of stress.

4. Discussion

This cross-sectional study aimed to investigate the prevalence and associated factors of neck and shoulder pain among school teachers in Oman. The study shows 98.3% of participants reported neck or shoulder pain in the past 12 months, with 46.5% of participants reporting pain in both the neck and shoulder. This prevalence is considerably higher than rates documented in Ethiopia (57.3%) [5] (China (48.7%) [11], and India (60.4%) [4] and exceeds pooled estimates from global systematic reviews reporting prevalence between 39% and 95% across teacher populations [1,2]. The elevated prevalence in our study may be attributed to increased sedentary behavior, extensive use of electronic devices, and prolonged static postures among Omani teachers, as supported by recent meta-analytical evidence linking sedentary behaviors to neck pain.

4.1. Physical Risk Factors

Contrary to international findings, this study did not observe statistically significant associations between neck/shoulder pain and work-related postural factors such as head-down posture, prolonged standing, or sitting, because almost all teachers reported neck or shoulder pain, making it difficult to find statistical differences between risk factors. This may explain why many variables were not significantly associated with pain in this study. For instance, Temesgen et al. (2019) [5] identified head-down posture and arm elevation as significant predictors of pain in Ethiopian teachers, while Chiu and Lam (2007) demonstrated similar associations among Hong Kong teachers [3]. The absence of significant associations in our sample may be explained by the near-universal exposure of Omani teachers to these ergonomic stressors, creating homogeneity that limits statistical discrimination. On the other hand, the unusually high proportion of participants classified as obese may be influenced by inaccurate self-reporting of height and weight, as the data were collected through a self-administered online questionnaire and were not objectively measured.

4.2. Psychosocial Factors

Psychosocial demands emerged as a critical risk dimension. Nearly two-thirds of teachers (62.8%) reported persistent psychological pressure, while less than one-fifth received consistent supervisor support. This aligns with evidence from Egypt and Saudi Arabia, where inadequate administrative support and high workloads were strongly linked to musculoskeletal pain [6,8]. Similar findings have been reported globally, highlighting the central role of stress, low job control, and poor organizational support in musculoskeletal disorders among teachers [11]. Despite relatively strong co-worker and family support, the persistently low level of supervisory support underscores the importance of organizational-level interventions, which are likely to be more effective than strategies targeting peer or social support alone. Also, preventive interventions must extend beyond ergonomic modifications to also address lifestyle and organizational-level factors.

4.3. Chronicity and Functional Impact

The chronic nature of musculoskeletal pain was obvious, with 59.7% of teachers reporting pain persisting for more than one year and 37.0% describing severe pain. Chronicity was closely linked with absenteeism (29.6%) and reliance on pharmacological management (43.2%), echoing reports from Ethiopia, Egypt, and Iran that long-term musculoskeletal disorders lead to functional impairment, increased sick leave, and reduced job satisfaction [5,8]. These findings are consistent with Iqbal et al. (2021), who emphasized the physical and psychological consequences of chronic neck pain, including reduced muscular endurance and heightened distress [12].

4.4. Individual and Behavioral Factors

Although physical exposures were not significantly associated with pain, behavioral and individual characteristics warrant attention. Only 11.5% of participants achieved the WHO-recommended physical activity threshold, supporting evidence from that regular exercise offers a protective effect against musculoskeletal disorders [5]. Moreover, the predominance of obesity in the sample (95.5%) represents an additional risk factor, consistent with Saudi and Egyptian studies linking higher BMI with musculoskeletal pain) [6,8]. Female predominance (89%) in the teaching workforce may further explain the high prevalence, as gender-related differences in musculoskeletal vulnerability have been consistently reported in the Middle East and beyond [13,14,15].

4.5. Comparisons and Implications

The findings of this study mirror global evidence that musculoskeletal pain among teachers is multifactorial, involving ergonomic, psychosocial, physiological, and organizational determinants. However, the exceptionally high prevalence in Oman highlights an urgent need for tailored interventions. Ergonomic training programs, stress management workshops, and structured physical activity promotion should be prioritized within school health policies. Additionally, organizational reforms to enhance supervisor support and reduce workload intensity could yield significant improvements in teachers’ occupational health.

4.6. Strengths and Limitations

A key strength of this study is its large, geographically diverse sample across three governorates, enhancing representativeness. Although the female predominance in our sample reflects the actual distribution of teachers in Oman (69.5% female vs. 30.5% male), the limited number of male participants (11%) may restrict the generalizability of findings to male teachers.

However, the extremely high prevalence observed in this study may reflect self-selection bias, whereby teachers who were already experiencing neck or shoulder pain were more likely to participate in the online survey. This may have led to an overestimation of prevalence and should be considered when interpreting the findings. The use of convenience sampling limits the representativeness of the study population and may reduce the external validity of the findings. Future research using probability-based sampling methods would enhance generalizability across the teaching workforce in Oman. Furthermore, the high homogeneity in exposure to physical risk factors may have obscured true associations. Longitudinal studies incorporating objective ergonomic assessments and physiological measures are necessary to clarify interconnections. On the other hand, the Confidence intervals were not reported, which may limit assessment of the estimate‘s precision.

5. Conclusions

The study did not find any significant associations with physical risk factors. However, it highlights the influence of broader determinants like low physical activity, obesity, and inadequate supervisory support on chronic neck and shoulder pain in teachers. These results emphasize the need for institutional interventions such as workload management, organizational support, ergonomic training, and promoting regular physical activity to alleviate neck and shoulder pain among teachers. This study shows relationships between risk factors and pain, but it does not prove that these factors directly cause pain.